


Endoscopic Follow Up

by SweatingHerLadyBollocksOff



Category: The Thick of It (TV)
Genre: Brief non-explicit references to potential cancer, F/M, Hospitals, I Don't Even Know, Implied/Referenced Domestic Violence, Malcolm Tuckers Handkerchief, Multi, Nicola's Going To Be Okay Though, She Will Learn To Love Herself, Sickfic, The Nic Gets Pancreatitis Fic You've Not Been Waiting For
Language: English
Status: Completed
Published: 2021-01-01
Updated: 2021-01-09
Packaged: 2021-03-10 19:27:48
Rating: Not Rated
Warnings: No Archive Warnings Apply
Chapters: 7
Words: 3,550
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/28482381
Author URL: https://archiveofourown.org/users/SweatingHerLadyBollocksOff/pseuds/SweatingHerLadyBollocksOff
Summary: Nicola's health takes a turn for the worse on leaving Westminster. Can she learn to look after herself?
Relationships: James Murray/Nicola Murray, Nicola Murray/Malcolm Tucker
Comments: 25
Kudos: 21





	1. May 10th, 2012

**Author's Note:**

> I really don't know what this is. Other than a desperate attempt to combine my two loves of sickfic and Nicola Learning to Love Herself. 
> 
> Some bleak content along the way but I'll try to appropriately tag, and Nicola is definitely going to be okay.
> 
> All dates changed on 03/01 due to my inability to research - apols!

Dr Emma Green,  
Addison Road Medical Practice,   
104 York Road,   
E4 8DJ

Mrs Nicola Murray, NHS no 45587943 DOB 05/12/1966

Date of clinic: May 10th, 2012

Dear Doctor, 

Many thanks for your two week wait referral for Mrs Murray, who I saw in clinic today with her mother, Jane, and our clinical nurse specialist Paula. Mrs Murray reports a three month history of weight loss, occasional vomiting, mostly in the mornings, and severe abdominal pain that is not relieved by over the counter pain relief. As you know, she has a background medical history of generalised anxiety disorder, severe claustrophobia, arthritis of the right thumb and benign stomach polyps. These polyps were diagnosed endoscopically some twenty years ago, following a period of some loss of appetite and early satiety, but have never caused significant symptoms or trouble. Biopsies taken at the time were benign. 

On examination, there was significant abdominal tenderness with guarding, the pain being most localised to the upper left quadrant. PR examination was normal. Mrs Murray declined a gynaecological examination at this time, but denies any unusual bleeding or other concerning symptoms. She wishes to speak to you further before agreeing to an examination, though I have explained the potential significance to her. 

In any other circumstance, I would recommend an endoscopy and colonoscopy, and a CT chest, abdomen and pelvis. Mrs Murray wishes to have some thinking time regarding the endoscopic procedures, but flatly refused to consider a CT. I would be grateful if you could speak to her further regarding this. We can offer sedation, or, if appropriate, referral to the open MRI centre in Swindon which has no claustrophobic elements. 

I would also be grateful if you could arrange some counselling or talking therapies for Mrs Murray, and discuss with her the possibility of medical interventions for her anxiety. I understand from our discussion today that she has recently lost her job and her marriage has broken down, and I do wonder if this might be contributing to her symptoms. 

With best wishes,  
Dr Mae Thomas,  
Gastroenterologist

(Copied to patient)


	2. May 15th, 2012

**Summary for the Chapter:**

> A woman's work is never done.

**Notes for the Chapter:**

> References to domestic violence, vomiting.

"-- if you're just going to stand there, you might as well fuck off". It came out weaker than she'd intended, but James seemed to get the message, leaving the bathroom and heading through the bedroom and downstairs. There was nothing worse than having a fucking audience. She wasn't even really throwing up anymore, just the sort of unproductive retching that left you with abs like a washboard, but it wasn't yet safe to leave, and she also didn't particularly want to go and talk to James about the future and plans and all that other shite. It had been his fucking big idea to leave, so surely he should be sorting all the life admin and practicalities. The thought of explaining to the kids that Dad wasn't going to be coming back from his trip to Auntie Karen's made her stomach roll again, and she heaved herself up from her sanctuary against the cold radiator. Every single part of her felt absolutely fucked. 

"Nicolaaaa!" Fuck off, fuck off, you useless fucking wanker. She'd only just about managed to get upright again, straightening out her clothes, brushing her teeth and hair and washing her face, and now he wanted something? A woman's work is never done. "What? If if it's something stupid, I swear to fuck, James-" she started, finding him at the kitchen table reading. Reading her hospital letter, and all those stupid leaflets she'd been given. "James! That's private - anyway, you don't even fucking live here, have a little respect" she hissed, snatching them from his hand and shoving them back in the drawer where she hid everything she didn't want to deal with. "You told them that your marriage had broken down? What the fuck does that mean, Nicky? Marriages don't 'break down', cars break down, it's not - I'm not letting you get a divorce, if that's what you want. I wasn't /leaving/, just needed some space because you were going fucking mental. Clearly still fucking mental, reading this" James fired back, reaching to get the letter out again. Nicola held the drawer firmly closed, which thankfully also put her just out of his reach. "Our marriage, James, never fucking went anywhere, let alone breaking down now. So I /am/ getting a divorce, and you /are/ leaving. The kids will stay here, until you arrange whatever shitty little custody deal you and your solicitor can cobble together. But it won't be anything very fucking substantial, let me tell you that now for free." James' face was slowly turning a shade of red that very clearly signalled danger. It was one of those primal, animal kingdom type things - pale, pallid, unshaven equals you should leave him, red, strained and slightly shaking means you should run. Like she could fucking run in this state. 

James scoffed, and even the noise that had been the background to the last two decades of her life was repulsive to her now. "So, what, you're going to get some big fuck off lawyer on your last pay check and use the last of your taxpayers money allowance to stop me seeing my fucking kids?" He snapped, and that was a low blow even for James. "I don't need a lawyer, James, if you recall. I did actually have a life, before you, and a career!" She was dangerously close to tears now, suddenly feeling very shaky and lightheaded. Everything was going a bit wobbly at the edges, fuzzy and dark and yet it seemed deeply comforting. Maybe if she just let that bit take over, the encroaching wobbly darkness, she could get some rest. "Are you going to be acting like that when you stand up in court?" was the last piece of James' fucking career advice that she heard before her legs crumpled, smacking her head hard on the kitchen counter as she fell. 

* * *

Consultant ward round  
Dr Mae Thomas  
15th May 2012 Castle Ward, Bed 12

PMH: anxiety, claustrophobia, arthritis, stomach polyps (benign), four pregnancies, perimenopausal  
Social hx: MARAC warning (domestic violence)

Presenting complaint: brought in by ambulance following witnessed collapse at home, loss of consciousness ?few minutes, trauma to head, on background of 2ww referral to UGI with weight loss, vomiting and abdo pain

Obs: see nursing note

\- Mrs Murray's main symptom at present is lightheadedness, awaiting CT head, thorax, neck, abdo pelvis to assess cause of fall.  
\- Abdominal pain relieved with IV morphine, anti-emetics given  
\- Ward team to call Mrs Murray's next of kin (Jane Thornton) to collect Mrs Murray's children from school and provide update on condition.  
\- I will liaise with seniors regarding appropriate sedation for CT given patient's ongoing lightheadedness  
\- Please flag CT report to me when available

Please ensure MARAC notes are reviewed by ward team - patient's husband Mr James Murray is not to be contacted or allowed to visit, as per patient's wishes. Mrs Murray has at this time declined further review for same, but I will speak to her again when well. 

Please note Mrs Murray is profoundly claustrophobic. If possible, a window bay (6, 12, 24) would be advised.


	3. May 16th, 2012

**Summary for the Chapter:**

> Mentions of potential cancer and non-graphic references to domestic violence.

Consultant ward round  
Dr Mae Thomas  
16th May 2012  
Castle Ward, Bed 12

PMH: anxiety, claustrophobia, arthritis, stomach polyps (benign), four pregnancies, perimenopausal  
Social hx: MARAC warning (domestic violence) 

Presenting complaint: BIBA following collapse, weight loss, vomiting, abdo pain  
?Pancreatitis  
??Pancreatic malignancy

\- Bleeped overnight by ward team, patients condition had deteriorated significantly  
\- Overnight Mrs Murray had become significantly distressed, crying out in pain despite increased IV pain relief, gasping for breath but was unable to tolerate masked oxygen  
\- Nasal cannula placed for supplemental oxygen, patient settled with same and pain subsided over twenty to thirty minutes  
\- Out of hours CT performed to assess cause - patient mildly sedated with Dexmedetomidine and tolerated admirably

\- CT Head Neck Chest Abdo Pelvis 16/05/12: no evidence of intercranial haemorrhage or trauma. Diffuse inflammation surrounding body, head and neck of the pancreas - likely chronic turned acute pancreatitis but pancreatic malignancy cannot be ruled out. Suggest MRI pancreas and endoscopic biopsy. 

Mrs Murray was asleep on my attendance during consultant ward round this morning, but was easily woken and happy to speak with me. I explained the results of her CT scan, that this showed a likely chronic pancreatitis that had now exacerbated to an acute medical emergency. Mrs Murray became very distressed at this point and asked me to leave. She no longer wished to speak to me. Once attended to by nursing staff, Mrs Murray felt calmer and was able to speak to me again, with ward sister Brooks. I apologised for causing her distress, and reiterated that this is a common condition which we deal with regularly and successfully. Mrs Murray denied any excessive alcohol use or smoking history, but admitted to significant and prolonged periods of stress, and to a much lengthier history of sharp, persistent abdominal pain than previously described to me in clinic. Abdominal examination consistent with pancreatitis. Mrs Murray has no family history of pancreatic cancer or other cancers, although she cannot provide a paternal history. 

I discussed with Mrs Murray the need for MRI pancreas and endoscopic biopsy, and what this would entail. She would like to be sedated as previous for both procedures - I advised her that we will arrange these as soon as possible to avoid further anxiety, and as such she will need to be nil by mouth after breakfast time today. Mrs Murray understood and was grateful for my update. She expressed that she was grateful for our care, and for our efforts in maintaining her confidentiality at this difficult time.

Please note Mrs Murray's mother Jane is visiting later today - Jane is Mrs Murray's next of kin following MARAC multi team meeting regarding her husband. Do not allow other visitors, or provide updates to anyone else.

Please bleep me or call my personal mobile if patient deteriorates.


	4. May 16th, 2012 - Night Shift

**Summary for the Chapter:**

> If you can't work out where you've read to after I had to change all the dates for historical accuracy, it'll be here! Only I could set this whole thing in the middle of the Inquiry 😩

Nursing note - 16th May 2012, 4pm

Ward team have recieved multiple calls today from a Mr Malcolm Tucker, asking to speak to Mrs Murray or receive an update on her condition. Initially no information was given, as per previous instruction. When Mrs Murray returned from her procedures and was being visited by her mother, ward sister Brooks discussed these calls with Mrs Murray and asked if she wished to speak to Mr Tucker. She was not keen to speak to him at this time, but consented to us providing her friend Mr Tucker with an update on her condition. She would be willing to see him should he visit. 

* * *

Nursing note - 16th May 2012, 6pm

Patient washed and dressed with assistance. Managed a small dinner (sandwich, yoghurt, fruit cup, juice.) After dinner Mrs Murray was visited by hospital volunteer team, had a short conversation with them, provided with newspapers, magazines, puzzle books, snacks. She became upset regarding her children, so I offered to call her eldest daughter Katie with her, which Mrs Murray appreciated. During this conversation, Katie expressed that she wished to speak to me individually, which was arranged. She expressed concerns about Mrs Murrays housing situation on discharge - the family home is in her husbands name and Katie feels he would not let them stay, and her mother's home is unsuitable for them all to live there. I advised Katie I would discuss with our discharge team, which she appreciated. Katie's telephone number added to patient record. 

* * *

Consultant Ward Round  
Dr Mark Lawson  
16th May 2012, 7pm

I spoke to Mrs Murray this evening to discuss the results of her MRI and endoscopy. She had been tearful earlier this morning following the procedures, but was more settled this evening. She wished to speak to Dr Thomas, but accepted that she was not available. We discussed her experiences, which she was happy to discuss and felt this helped her to "process things". I explained that the MRI and endoscopic appearances are consistent with pancreatitis, but we have taken biopsies to ensure. The biopsy may have caused some swelling, hence she may have some further pain this evening, to discuss with nurses if pain relief not sufficient. She was grateful for the update and expressed she wished to go home as soon as possible. I reassured her that we will facilitate her discharge as soon as possible. 


	5. May 17th, 2012

Nursing note, 17th May 2012

Patient slept well, had small breakfast. Slightly tearful, misses her children. Reassured we could speak to them later if she wishes. Call recieved from Mr Malcolm Tucker - update provided. Will visit later - patient informed and agreed.

* * *

"-- Nic'la? Sorry, I didnae want to wake you, but I can't stay long. Please don't hit me". His voice was just the same as it had ever been, she didn't even need to open her eyes to know who it was, and there was a crinkly sound near her head that could only be conciliatory flowers. She probably didn't have the energy to hit him, much as she'd like to. Plus, it wouldn't do her any good to get kicked out of the hospital for bad behaviour. The world was far too bright when she opened her eyes, and Malcolm was far too - smart. He was still wearing a suit, for fucks sake. Surely he couldn't still be working, not when - oh, right. It was only her world that was ending, not the entire thing. Her own personal apocalypse. Lucky, lucky me. "Whaddyouwant?" She mumbled, rubbing her eyes and sitting up slowly. "Just came to make sure ye were okay, lass." It stung, the ridiculousness of it all, and for the second time today Nicola found herself on the verge of tears. "You had to /ask/? I'm fucking-" she started, before realising the nurses were looking at them. "I'm ruined, Malcolm. I'm jobless, getting a divorce, probably fucking homeless -" she realised, her voice just above a whisper but no less sharp for her lack of energy. "James is never going to let me stay there." She was pretty much just thinking out loud now, but for once he was letting her talk. "And now my fucking - do you even know what a pancreas is? /I/ don't even know what a pancreas is" she admitted, and somehow she couldn't hold it back anymore, the hot stinging tears that slipped down her dry, pallid cheeks.

A scratchy, thin hospital issue tissue only made her feel worse. How could the tissues be so shit, when the whole point of hospitals was that everyone cried all the time? "Here-" Malcolm murmured, reaching into his inside pocket and handing her a clean, ironed hanky. "Are you fucking kidding?" She muttered, utterly baffled by the relic of the Victorian era he was proffering. "Yknow these are massively unhygienic, right?" But it was only a few tears, and the soft cotton was much more soothing than the harsh one ply tissue, more so for the fact that it smelt like Malcolms washing powder than anything else. He didn't say anything, which was almost definitely for the best. "Listen, I-" he started, and she shook her head and handed his hanky back to him. "You've got to go, Malcolm. We've got the inquiry in a few weeks, and I need to get better, and we need to - to not see each other." He nodded, completely understanding. He wasn't supposed to be here. Without another word, he got up off the end of her bed and straightened the blankets, offering her one last small, sad smile before heading out. "Get well soon", the card in the flowers read, and it seemed so hopelessly optimistic that she nearly burst into tears again.

_Feel better, Nicola, honestly. Take care of yourself. Ring me if you need a lawyer. M_


	6. December 4th, 2012

**Summary for the Chapter:**

> Nicola finds her feet.

Dr Emma Green,  
Addison Road Medical Practice,   
104 York Road,   
E4 8DJ

Ms Nicola Thornton, NHS no 45587943 DOB 05/12/1966

Date of clinic: December 4th, 2012

Dear Dr Green,

I met Ms Thornton in clinic today accompanied by her mother, Jane. She was recently admitted here with collapse secondary to pancreatitis, which resolved on admission and did not require intervention. She was discharged on PRN codeine, which I am glad to hear she no longer requires. In the main, Ms Thornton is in good health, and abdominal examination was reassuringly normal.

Ms Thornton and I discussed the likely causes for her acute pancreatitis at her request. I explained that her condition was likely caused by prolonged periods of stress, although I did explain that this is not an entirely known phenomenon, and sometimes there is no simple cause that can be identified. Ms Thornton explained to me that she has been seeing a therapist, and is practicing gentle yoga, and feels much better in herself and her mental health, which I was glad to hear. She is hoping to find a new job in the New Year, and I wish her the best of luck. I will see her in clinic in a year's time to ensure her recovery continues to go smoothly.

Addendum: Please could you kindly provide patient with prescription for steroid cream / assessment of the rash on her arm that she showed me in clinic today. It appeared entirely benign and eczemetous.

With very best wishes,   
Dr Mae Thomas  
Gastroenterologist

(Copied to patient)


	7. December 3rd, 2013

"--Nic'la? Ye alrigh'?" His words were gentle and genuine, even as they were yelled up the stairs, but she knew that what he'd wanted to say was "hurry up Nicola, we're going to be late". Which was true. "I'm just coming!" She called back, checking the mirror quickly and fluffing up her curls, grabbing her handbag and dashing downstairs. Halfway through trying to zip up her little ankle boots, bent over in the hallway with her curls flopping in her eyes, there was a familiar steady presence behind her, cold hands snaking around her waist and long fingers against her tummy through her silky shirt. "We really are going to be late if you start with all that" she protested, standing up and turning in his arms to give him a soft, tender kiss. "Aye, well, we could always ditch the doctors and just go straight to lunch. Or straight to bed, cut out the bit in the middle entirely" Malcolm offered with a grin playing at the edge of his lips, before shaking his head. "C'mon, let's go." He carefully let go of her, mindful not to disturb the artful way she'd tucked her loose floral print shirt into her jeans, since it had probably taken at least five attempts. He grabbed the keys from the side and ushered her out the house, slipping his hand into her back pocket for a reassuring arse squeeze. Unconventional, but effective, and nothing about _this_ could be considered anywhere adjacent to conventional. People who'd been hurt like that weren't supposed to fall in love with the one who'd encouraged them to hurl themselves with enthusiasm onto the sword. People who made a habit of promoting self-stabbings weren't supposed to be _allowed_ to fall in love with soft, woodland women who ate pizza from the inside out. Perhaps conventions were shit. Perhaps everything from a gentle bum squeeze to a filthy, drawn out blowjob to buying the posh custard in Tesco could mean "I love you". It certainly seemed to be working for them. 

* * *

Dr Janet Brooks,  
The Bailey Practice  
78 Princes Street  
London  
E17 9HS

Ms Nicola Thornton, NHS no 45587943 DOB 05/12/1966

Date of clinic: December 3rd, 2013

Dear Dr Brooks, 

I met Ms Thornton in clinic today, accompanied by her partner Malcolm. I was very pleased to see her in excellent health and high spirits. Ms Thornton reports no ongoing concerns about her health, no abdominal pain and a much decreased history of nausea, though she occasionally feels unwell upon waking in the morning. Her partner Malcolm reports that this is often resolved upon eating something small such as biscuits or rice cakes before a more substantial breakfast, and I encouraged them to continue to use this approach if helpful. Her appetite in general is much improved, she takes a varied diet including plenty of fruit and vegetables, and has reduced her previous perceived reliance on supplements by becoming more aware of the nutritional benefits of different foods. Her current regular medications/supplements are only the mini-pill, a daily multivitamin and venlafaxine, which she is finding particularly helpful for management of her anxiety and claustrophobia. She reports feeling much more aware of her health and how to maintain good health, though not anxious about this, which appears to me to be a sensible approach. I can see from her notes that Ms Thornton is now engaging with the cervical screening programme, showing a marked improvement in her anxiety over medical procedures, for which I understand you have given her much appreciated support. 

I have made no further routine follow up for Ms Thornton, but have advised her that if she experiences any unusual symptoms or has any concerns, she can telephone our administration team and book an open access follow up appointment. Please do not hesitate to re-refer this lovely lady if you have any future concerns, though I hope she remains well and content. 

With very best wishes,  
Dr Mae Thomas,   
Gastroenterologist.

(Copied to patient)


End file.
